What Veterinarians in Illinois Need to Know About Telehealth
Telehealth is an emerging and exciting opportunity for veterinary practices in Illinois, but one that presents legal, ethical, and technological challenges. If your practice is thinking about offering telehealth, telemedicine, or mobile health services, consider the challenges before you start, so you can build compliance into your process.
Are your clients practicing social distancing, making them reluctant to bring their animals to your office? During more normal times, are they too stressed or busy to visit in-person? Do you treat animals in remote areas, and spend too much non-billable time traveling from site to site?
If some of your patient visits, post-visit monitoring, and other tasks can be handled over available technology, you’ll save yourself and your clients time. Your animal patients, too, will likely feel more relaxed and cooperative in their familiar surroundings.
Telehealth is a big part of the future of medicine – and it is not just for humans! Using technology as a tool to augment your veterinary medicine practice can enhance your business and better serve your patients (and their human parents). But before you take the leap, it is critical to understand the complexities and legal challenges of providing telehealth.
What is Telehealth? What about Telemedicine?
Though the terms are often used interchangeably, telehealth is an umbrella term encompassing any use of technology to remotely deliver health information or education (such as tele-advice, tele-monitoring or tele-triage). Telemedicine, specifically, is the use of medical information exchanged between remote sites to improve or treat a patient’s health condition. Essentially, a telemedicine visit, though accomplished via technology between a remote patient and provider, should provide the same level of care as a regular office visit.
According to the American Veterinary Medicine Association, telemedicine should only be conducted within an existing Veterinarian-Client-Patient-Relationship (VCPR). The concept of the VCPR is strongly recognized under Illinois law, and generally requires that the veterinarian has recently seen and is personally acquainted with the animal patient by virtue of examination, or by virtue of regular visits to the site where the animal is maintained. Importantly, under Illinois law, a VCPR cannot be solely based on telephonic or other electronic communications.
Therefore, if you are considering incorporating telehealth into your practice, it will be important to analyze and carefully document that you have an established VCPR with each patient before permitting them to use your telehealth services. You must also remain readily available for follow-up, or have a designated back-up provider, so it will be important to ensure that you have the means and ability to meet this requirement for your patients, even those who are primarily utilizing telemedicine.
Legal and Ethical Obligations
Though there is little statutory guidance for veterinarians practicing telemedicine (unfortunately the Illinois Telehealth Act has not been extended to cover veterinarians), it is likely that a careful legal analysis of your practice and the existing laws governing the profession will allow you to legally operate a practice that includes telemedicine.
Veterinarians undoubtedly will have all of the same ethical and legal obligations when practicing telemedicine as they do for in-office or on-site visits with patients. Veterinarians must only practice within their normal scope of practice, and will be responsible for ensuring that using telehealth technology to provide telemedicine does not lower the standard of care they are providing. Some procedures or services may be appropriate to provide via telemedicine, while others may not. Although it is tempting to think of telemedicine as a simple process, it will require a case-by-case analysis to determine the most appropriate way to incorporate telemedicine into your practice.
Similarly, using the services of your veterinary technicians in your telemedicine practice will require a careful balancing of their skills, the law, and your supervision to ensure that you remain in compliance with your ethical and legal obligations as a veterinarian.
What About Prescribing Medications?
The laws regarding prescribing drugs are probably the most important to consider when designing your telemedicine practice; not only does Illinois law regulate prescription drugs, but the Federal Food, Drug & Cosmetic Act applies to many veterinary prescription drugs. Depending on the medication prescribed, you may not be able to initially prescribe, change the dosage, or refill certain prescriptions via telemedicine. It is important to analyze this closely to avoid potential legal pitfalls, especially for controlled substances.
Recordkeeping and Privacy Considerations
Just like an in-person patient visit, electronic visits or other telehealth interactions with clients and patients must be properly recorded, and the records must be properly maintained. It is important to consider your current record-keeping process and how it will be modified to address the unique aspects of telehealth interactions, as well as ensuring the security and privacy of the client and patient data transmitted or exchanged via telehealth.
Enhancing Your Practice with Telehealth Services
Telehealth is more than just telemedicine, so even if you aren’t ready to fully incorporate telemedicine into your existing veterinary practice, you might be considering spending a few off hours answering phone or Skype calls, or responding to electronic inquiries via an app or service like AirVet or Fuzzy Pet Health. There are some carveouts under Illinois law from the traditional practice of veterinary medicine that can make this a promising opportunity, but you’ll need to make sure you stay within the bounds of the limitations of the law and your ethical obligations as a veterinarian.
Only general information and advice should be provided, that is not specific to a patient, diagnosis or treatment. Before you begin offering these services, you should ensure that you have drawn clear boundaries that are available to those taking advantage of your services, and that you have appropriate and available resources to provide to clients that you determine require in-person or emergency care.
Resources
If you think providing telehealth or telemedicine services is for you, but the technological aspect seems daunting, there’s no need to reinvent the wheel. Companies are pioneering new telehealth technologies all the time, including ones specifically designed for veterinary practices. LiveDVM (currently transitioning to AirVet), for example, offers clients phone call, text or video appointments for a set fee. The model is set up to direct clients to their pets’ existing veterinary practice, unless they are unavailable (in which case a backup provider can provide some guidance, or direct the client to an emergency veterinarian if necessary). For a yearly fee, veterinarians can join the network, and set up shifts for off hours phone calls and electronic visits for their patients.
The AVMA Telehealth Resource Center also provides basic information about incorporating telehealth appropriately into your practice. (But note: while helpful, the information contained there is not specific to Illinois, nor does it address the nuance necessary to make sure your practice is in compliance with all of the applicable laws and regulations.)
Televet Services During the COVID-19 Pandemic
In response to the COVID-19 pandemic, the Food and Drug Administrations announced that it would waive certain portions of the federal veterinarian-client-patient relationship (VCPR), which normally would require in person visits. The FDA noted in its press release that it intends not to enforce the animal examination and premises visit VCPR requirements relevant to FDA regulations governing Extralabel Drug Use in Animals and Veterinary Feed Directive Drugs. However, this policy is temporary, and the FDA will release a new notification once this enforcement discretion will no longer be active.
Before you change how your veterinarian practice approaches veterinarian-client-patient relationships, be careful. The FDA’s choice to not enforce certain federal requirements only extends to visits of farm animals and off-label use of prescriptions for animals. This does not apply broadly across the board to all veterinary visits.
Jackson LLP’s Experienced Attorneys Understand Televet Laws
Jackson LLP’s focused attorneys work closely with veterinary and medical practices on all aspects of day-to-day operations, including telehealth. Understand your legal and ethical responsibilities as they relate to the use of telehealth, and stay apprised of new legal developments that might impact your veterinary practice.
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